A multi-centred, prospective randomised controlled trial comparing the effectiveness and cost of a static air mattress and alternating air pressure mattress to  prevent pressure ulcers in nursing home residents.

Professor Dimitri Beeckman et al.

Since the introduction of alternating air pressure mattresses and cushions  (high technology) to the healthcare sector several decades ago, they have become a popular and frequently used intervention for the prevention and management of pressure damage. However, Lead clinicians will often report the overprescription of these systems because the staff delivering day-to-day care feel this gives the patient the best outcomes compared to the low-technology systems available.

In this study, the authors and research team consider if this is the case by conducting a randomised controlled trial in response to several systemic reviews stating that there is a lack of evidence comparing the two systems and this is also recognised in the 2014 EPUAP guidelines(1).

The study follows 308 residents in 26 nursing homes, all at risk of pressure ulcers., to compare the number who developed category 2 or greater  pressure damage, those nursed on alternating pressure mattresses and the usual cushion for pressure area care used in the home or those on Repose mattress overlay and repose cushion.

Across the study, 11 different alternating systems were used.

The care home staff were all given the same training for pressure area care, and weekly spot checks were performed by the research team to ensure the accuracy of the recording.

Over the two weeks, residents' skin was monitored, and 11.7% developed category 2 or greater pressure ulceration using the alternating systems compared to 5.2% on the repose, which gives a  statistically significant result of P=0.04

Of those who did develop ulcers, it took 5.4 days to develop using the alternating system compared to 10.7 days with repose, meaning you will stay pressure ulcer-free for twice as long on the repose, and this gave a statistically significant difference P=0.05  There was no difference in which areas of the body pressure ulceration formed between the two groups

In the study, the team also compared costings over two and nine years, taking into account the need to purchase new systems and again found in favour of Repose.

In their conclusion, the authors state that a static air mattress was more effective than an alternating air pressure mattress in preventing ulcers in a high-risk nursing home population.

1. National Pressure Ulcer Advisory Panel (NPUAP), European Pressure Ulcer Advisory Panel (EPUAP) and Pan Pacific Pressure Injury Alliance (PPPIA) (2014a) Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. Emily Haesler (ed.). Cambridge Media, Osborne Park, Western Australia.